Medical interviewing by exemplary family physicians

BACKGROUND. Little is known about the extent to which models of ideal physician-patient interviews are actually practiced by physicians. This study examined physician-patient communication during medical interviews by exemplary family physicians. METHODS. We performed a cross-sectional study of verbal exchanges using 300 transcripts of office visits made to two groups of family physicians: 9 exemplars and 20 controls. The exemplars were family physicians with fellowship training in family therapy; the control group consisted of a convenience sample of board-certified family physicians with no special training in communication skills or counseling. Data were collected from June 1995 to July 1996. Physician statements were rated according to the Level of Physician involvement model, which measures physicians' abilities to collaborate with patients and address the psychosocial concerns of patients and their families. Patient satisfaction ratings were obtained by a research assistant immediately after the visit. RESULTS. Compared with the control physicians, the exemplars showed higher levels of psychosocial involvement with patients during routine office visits. In particular, they involved patients more in the medical interview, offered more emotional support, and showed more family involvement. Despite this greater depth of involvement, the length of office visits did not differ between the two physician groups. CONCLUSIONS. Our findings show that exemplars were more involved with their patients and provided more family- oriented care than community physicians. Exemplars routinely applied a biopsychosocial approach, collaborating with patients and addressing psychosocial topics without sacrificing efficiency, while community physicians focused on biomedical issues.